Preliminary Questionnaire

Complete and submit our convenient online questionnaire or
Download pdf version and fax to: (954) 252-3812 or (954) 776-4876.

Please help us by providing as much information as possible.
Please contact us if you need any assistance.

Privacy Pledge:
Pick Me & Moore believes that strong electronic privacy is crucial for the
ongoing success of the Internet as a service, commercial, and entertainment medium.
We pledge that Pick Me & Moore will not release your personal data to anyone else without your consent.

Section 1: Contact Information

	*Indicates Required Fields
	*First Name
	*Last Name
	Company Name
	Title
	Address 1
	Address 2
	Suite
	City
	State
	Zip Code
	Telephone
	Cell Phone
	Fax
	*Email
	Other Information/Comments

If you need help with any of the following sections, please do not hesitate to contact us.

Section 2: Your Foundation - Let's See what you have so far

Do you have a domain name?	Yes No	If Yes, what is it?
Do you have a Web host?	Yes No	If Yes, what company?

Section 3: Web Site 'Domain' Name - What Will You Name Your Web Site?

If you answered NO to the question above about a domain name please give us your choices.
Choice #1: www.			Choice #3: www.
Choice #2: www.			Choice #4: www.

Section 4: What is the Purpose of Your Web Site?

Informational	Promote Service	Promote Products	Provide Downloadable Information
Sell Service	Sell Products	Other:

In as much detail as possible please describe what you hope to achieve with your web site:

Section 5: Keywords and Short Phrases People Will Use to Find You on the Internet?

1.		6.
2.		7.
3.		8.
4.		9.
5.		10.
	Comments:

Section 6: What 'Style' or 'Image' Would You Like?
List web sites that you think are most like the 'style' or 'image' you would like for your web site.
Choice #1: www.			Choice #3: www.
Choice #2: www.			Choice #4: www.

Section 7: Logo, Photos, Graphics, Other Artwork, Animation, Sound

	Logo
			Do you have a logo? Yes No If 'Yes', can you provide your logo on disk or send it by email? Yes No

	Photos
			Do you have photos for your web site? Yes No If 'Yes', can you provide these photos on disk or send it by email? Yes No

	Graphics
			Do you have any graphics for your web site? Yes No If 'Yes', can you provide these graphics on disk or send it by email? Yes No If 'No', we can include the cost of the creation of graphics in our quote.

	Animation
			Would you like to have any animated graphics or text on your web site? Yes No If 'Yes', we can discuss the type of animation and include the cost in our quote to you.

	Sound
			Would you like to have any sound or music on your web site? Yes No If 'Yes', we can discuss the type of sound or music and include the cost in our quote to you.

	Comments:
		Tell us more about any other artwork or graphics you would like:

Section 8: Web Site Layout and Page Titles


Based on the example above, fill in your Web Page titles in the text boxes below. Fill in only as many as you think you'll need. (Page name examples in addition to the Home Page are: About Us, Services, Products, Press Release, Blog, Links, Location, Contact Us)
Home Page

Page Name #1	Page Name #2	Page Name #3	Page Name #4


Page Name #5	Page Name #6	Page Name #7	Page Name #8


Page Name #9	Page Name #10	Page Name #11	Page Name #12


Page Name #13	Page Name #14	Page Name #15	Page Name #16


Page Name #17	Page Name #18	Page Name #19	Page Name #20

Section 9: Security Test - Are You a Human or Computer?

We hate spam as much as you do. To help us curb this practice please identify the picture below.

Thank you for taking the time to fill out our questionnaire.

Preliminary Questionnaire

Please help us by providing as much information as possible. Please contact us if you need any assistance.

Section 1: Contact Information

Section 2: Your Foundation - Let's See what you have so far

Section 3: Web Site 'Domain' Name - What Will You Name Your Web Site?

Section 4: What is the Purpose of Your Web Site?

Section 5: Keywords and Short Phrases People Will Use to Find You on the Internet?

Section 6: What 'Style' or 'Image' Would You Like?

Section 7: Logo, Photos, Graphics, Other Artwork, Animation, Sound

Section 8: Web Site Layout and Page Titles

Section 9: Security Test - Are You a Human or Computer?

Please help us by providing as much information as possible.
Please contact us if you need any assistance.